1979, 10-11 Permit: 79-5803 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTYt"BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
1. s ?a /T A '/4'
LOT B OCK UBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
E5 c 4 n -a c vszE
PHONE
PARCEL NUMBER/S
ADDRESS
'jj0 9 //a -mover
CONTRWTOR
A,
v, 2/ or`/9_?t 7 P—
ZIP
yid®d
PHONE
Required Set Backs In Feet
North ISouth
East
(West
Size of Parcel -. 1 Zone Classification
ZIP
/�a7.-70
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
•
5.
PHONE
Valuation 1 Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area Garage Area
Storage
6.
TYPE
7. OF
WORK
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
8.
9.
❑ NEW
❑ BLD.
DESCRIBE WORK
VALUATION
❑ ALT.
O PLMB.
❑ AD'N.
❑ MECH
Source
of
Utilities
O RPL.
O M.H.
0 MVE.
0 OTHER
0 POOL
GAS I ELECTRIC
No. Baths
No. Floors
No. Rooms
Rec. Room
WATER
CERTIFICATE
of EXEMPTION
SEWER
Req'd.
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or -local law regulating constru ion or the
performance of
construction.
DATE /D /� SIGNATURE
DEPT.
SPECIAL APPROVALS
. REC'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE1O
11
OFFICI
APPR
Rec'd.
Not Req'd.
• FEES COLLECTED
Single $
Building
Plumbing Yet SD
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
srgeot
PERMIT NUMBER
DATE
03* *3050
*3050
*3Q506
E *000 3
580.22
10-11779
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
TH I S� B�C OIyI �S�A y, IF B M I T.
5180.32 *30.5001-
R ISSUANCE _